Healthcare Provider Details

I. General information

NPI: 1235402819
Provider Name (Legal Business Name): WILLIAM HAROLD PARHAM SR. CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2012
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 CARTHAGE ST
SANFORD NC
27330-4162
US

IV. Provider business mailing address

110 VINSON RD
MC INTYRE GA
31054-2091
US

V. Phone/Fax

Practice location:
  • Phone: 919-774-2100
  • Fax:
Mailing address:
  • Phone: 478-946-2640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number97167
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: